Luke Orton was playing in a rugby tournament on the Isle of Wight in July 2023 when his life changed forever.

The U.S. Preventive Services Task Force (USPSTF) plans to add self-collected human papillomavirus (HPV) testing to its recommendations for cervical cancer screening, among other changes.
Task Force Chair Wanda Nicholson, MD, MPH, MBA, of the Milken Institute School of Public Health and George Washington University School of Medicine in Washington D.C., said evidence shows that patient self-collection and clinician collection yields similar results.
“There’s no difference in accuracy, and in fact, the self-collection can promote higher screening rates among women who are either under-screened or [have] never been screened,” Nicholson told MedPage Today.
While self-collection was on the Task Force’s radar for many years, it has not previously been part of the USPSTF cervical screening recommendations. In May, the FDA approved swab-based self-collection for HPV testing in healthcare settings, though ob/gyns told MedPage Today this option does not entirely replace the utility of Pap smears and the U.S. still lags behind other nations in self-collection outside healthcare facilities.
Nicholson also noted that most women with cervical cancer are either under-screened or had never been screened, and that African American, Hispanic, American Indian, and Alaska Native women — as well as women living in rural areas — die from cervical cancer at higher rates. The Task Force hopes that adding self-collection will improve screening among these at-risk populations.
Jessica Kingston, MD, of UC San Diego Health, who was not part of the Task Force, told MedPage Today that self-collection makes screening more inclusive to people wary of the speculum or who have had traumatic experiences.
“Most healthcare professionals think [getting a Pap test] should be just part of someone’s routine of staying healthy, but many people find that a big hurdle to come over,” Kingston noted. “With self-collection, we’re really kind of combining what we know about what causes cervical cancer and making it much more feasible for a wider population.”
Much of the rest of the draft recommendation statement aligns with previous recommendations, which were last updated in 2018. There are no planned changes for women ages 21 to 29, who still should be screened for cervical cancer every 3 years with cervical cytology, the draft statement said.
Women ages 30 to 65 should be screened with an HPV test every 5 years, either with clinician or patient-self collection. However, the Task Force also emphasized that getting a Pap test every 3 years, or co-testing with a combined HPV and Pap test every 5 years, are effective alternative screening options for this group. In the updated draft recommendation statement, all these options still received an A grade recommendation.
“What’s new and different is that we have identified HPV as being an optimal screening test in the sense that it has the best balance of benefits and harms,” Nicholson said, meaning it detected early signs of cervical cancer with fewer unnecessary follow-up tests.
Additionally, some groups still don’t need to be screened for cervical cancer. This includes women younger than 21, women who have had a total hysterectomy and don’t have a history of cervical cancer or a high-grade precancerous lesion, and women older than 65 who previously had regular screenings with normal results and are not otherwise at high risk for cervical cancer, all of which get a D grade recommendation.
For this review, the task force considered 81 fair- to good-quality studies. Of these, 19 looked at benefits or harms of HPV-based screening strategies, 22 looked at the accuracy of self-collection in HPV tests, 42 reported on uptake of self-collected HPV tests, and one trial assessed diagnostic accuracy and uptake.
The recommendations apply to cisgender women and people assigned female at birth, including transgender men and some nonbinary people. They do not apply to people with increased risk of developing cervical cancer, including women with HIV, those with compromised immune systems, or those with a history of precancerous lesions or cervical cancer. People with these risk factors should receive condition-specific management.
Supporting evidence for the USPSTF recommendations, including a draft evidence review and modeling report, were posted for public comment on the Task Force website. Comments can be submitted online through Jan. 13, 2025.

Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow

Disclosures
Nicholson and Kingston reported no disclosures.

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For people with aneurysmal subarachnoid hemorrhage and anemia, there was no significant neurological benefit from getting red blood cell transfusions more liberally, the SAHARA randomized trial showed.
Between a liberal transfusion strategy (mandatory transfusion at a hemoglobin cutoff of ≤10 g/dL) and a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g/dL), an unfavorable neurological outcome was similarly likely at 12 months (33.5% vs 37.7%, RR 0.88, 95% CI 0.72-1.09).
Administered during the critical care period for people hospitalized for an aneurysmal subarachnoid hemorrhage, liberal and restrictive strategies were also associated with no different rates of adverse events and other secondary outcomes:Functional independence at 12 months (per Functional Independence Measure scale): 82.8 vs 79.8 pointsQuality of life (QoL; per EuroQol five-dimension, five-level utility index): 0.5 in both groupsHealth status or QoL (per visual analog scale): 52.1 vs 50 pointsMortality at 12 months: 27.2% vs 27.1% (RR 0.99, 95% CI 0.77-1.28)
Researchers led by Shane English, MD, of Ottawa Hospital and University of Ottawa, Ontario, reported the SAHARA findings in the New England Journal of Medicine.
The best threshold for blood transfusions remains controversial in critically ill patients — existing guidelines only offering “vague recommendations to maintain hemoglobin levels within the normal range or to transfuse in the case of anemia,” according to English’s team.
While a liberal transfusion strategy might improve oxygen delivery and reduce brain tissue hypoxia, it has the potential downsides of increasing complications and mortality.
In this summer’s HEMOTION trial report, compared to an even stricter restrictive approach (transfusion at a hemoglobin level of ≤7 g/dL), a SAHARA-type liberal blood transfusion strategy failed to reduce the risk of an unfavorable neurologic outcome at 6 months when applied to critically ill patients with traumatic brain injury and anemia.
Soon afterward, however, the TRAIN trial results came out favoring a liberal strategy (hemoglobin cutoff

Have you wished you could be exempt from prior authorizations, especially because your procedures or prescriptions are almost always approved?
That’s the idea behind “gold card” laws some states have implemented, but the laws have not always worked out quite the way supporters have envisioned.
Take Texas, for example. Under that state’s gold card law, passed in 2021, “a health maintenance organization or an insurer that uses a preauthorization process for healthcare services may not require a physician or provider to obtain preauthorization for a particular healthcare service if, in the most recent 6-month evaluation period, the health maintenance organization or insurer has approved or would have approved not less than 90% of the preauthorization requests submitted by the physician or provider for the particular healthcare service.” As with other gold card laws, the privilege is supposed to be automatically granted, without the provider having to do anything.
Although that 90% figure may sound like an easy bar to clear, only 3% of the state’s healthcare providers have so far received a gold card, according to a January 2023 survey from the Texas Department of Insurance. “We do not have any data to indicate that the percentage will increase,” a spokesperson for the department said in an email.
Granular CPT Codes
Zeke Silva, MD, chair of the Council on Legislation at the Texas Medical Association (TMA), said that in getting the law passed, “we had hoped if a physician did a procedure that was common for them, that was in their sphere of expertise, and for which they almost always received prior authorization approval, going forward, they would no longer have to go through the process. So the goal was very logical.”
However, “it’s become difficult for physicians in that circumstance to satisfy the threshold to earn a gold card,” he continued, noting that a physician must have a particular service approved a minimum of five times during the 6-month period being considered. “While that sounds like it wouldn’t be hard to achieve, CPT [Current Procedural Terminology] coding is very granular.”
For example, in radiology — Silva’s specialty — “there’s a different CPT code for a chest CT without contrast, with contrast, and then with and without contrast, which is good because it allows you to report what you’re doing in a fairly granular fashion,” he said. “The downside is, if you’re a pulmonologist and you’re trying to get prior authorization for a chest CT, some of your patients might need contrast, some may not, and some may need both,” so getting five approvals for a particular CPT code suddenly becomes more complicated. The same is true for accumulating prior authorizations for the same medication with different dosages and different therapeutic regimens.
He added that there’s another problem, and that’s lack of transparency from the insurers about how they’re awarding the gold cards. “There’s no transparency on the data for anyone to specifically know” why so few providers are receiving them, he noted. “We thought the plans were going to be forthright in how they’re evaluating physicians … Without seeing the data, we certainly can’t correct [the problem].”
Hoping for Change
The TMA is hoping to persuade the state legislature to make several changes to the law, Silva said. One change would be to do away with the five-case minimum. “We take a position even as few as one, if they’re approved, that number should be sufficient.”
The TMA also would like to see the duration of the gold card exemption — currently lasting for 6 months — to change to 1 year, “so that physicians aren’t constantly having to engage or think about this process,” he said. And finally, the TMA would like more transparency from health insurers regarding what services are being reviewed and how decisions are being made.
The association has had some other successes regarding prior authorization, he added, including getting the legislature to exempt treatment of autoimmune conditions from prior authorization requirements. “We had always focused on relieving the physician burden, but that bill was interesting because it was patient-focused,” he said. “We’re thinking about going into the next [legislative] session expanding on that mindset,” and getting the legislature to exempt patients undergoing cancer treatment or treatment for a chronic disease.
In addition to Texas, other states with gold card laws include Arkansas, Colorado, Louisiana, Montana, and West Virginia, according to the National Conference of State Legislatures. Louisiana’s law applies only to prior authorization for drugs to treat mental health conditions.
Colorado’s law, which was passed this year, is a little different from the others, requiring health insurers and pharmacy benefit managers to “adopt a program, developed in consultation with providers participating with the carrier, to eliminate or substantially modify prior authorization requirements in a manner that removes the administrative burden for qualified providers as defined under the program, and their patients for certain prescription drugs and related drug benefits based on certain criteria.” The deadline for implementing the program is Jan. 1, 2026.
Gold Card Laws’ Evolution
Gold card laws have been undergoing an evolution, said Emily Donaldson, principal at the consulting firm Avalere in Washington, D.C. “When we first saw gold carding legislation being discussed, it was more on the medical services side, and as the legislation has evolved, we have now seen states also apply gold carding to prior authorization for medicines, or subsets of medicines,” she said during an interview with a public relations person present. “I think those of us who follow health policy understand that there is no silver bullet or one solution to a problem, and that includes some of the challenges patients and providers face with prior authorization.”
Donaldson said she wasn’t surprised at how few providers in Texas have gotten gold cards. “If you look at the legislative text itself, there is fairly broad discretion given to the health plans and how they design their gold card programs,” she said. “And so that may be a factor in why you see these differences between programs, when maybe some plans have more providers receiving a gold card than others, and why maybe it’s not working the way that providers thought it might work when the legislation was initially passed.”
She said she has seen an uptick in states looking at gold card laws — “even if states haven’t passed something, they may have proposed something that hasn’t made it through the legislative process.” She said she thought states would learn from the experience of states like Texas and use that information when they’re developing their own legislation.
An insurer organization did not respond by press time to a request for comment on the gold card issue.

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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Americans should eat more beans, peas, and lentils and cut back on red and processed meats and starchy vegetables, all while continuing to limit added sugars, sodium, and saturated fat.
That’s the advice released Tuesday by an expert panel of nutritionists charged with counseling the U.S. government about the 2025 edition of the dietary guidelines that will form the cornerstone of federal food programs and policy.
But the 20-member advisory panel didn’t weigh in on the growing role of ultraprocessed foods that have been linked to health problems, saying there’s not enough evidence to tell people to avoid them. And the group steered clear of updating controversial guidance on alcohol consumption, leaving that analysis to two outside reports expected to be released soon.
Overall, the recommendations for the 2025-2030 Dietary Guidelines for Americans sound familiar, said Marion Nestle, PhD, MPH, of New York University, a food policy expert.
“This looks like every other set of dietary guidelines since 1980: eat your veggies and reduce consumption of foods high in salt, sugar, and saturated fat,” Nestle said in an email. “This particular statement says nothing about balancing calories, when overconsumption of calories, especially from ultra-processed foods, is the biggest challenge to the health of Americans.”
The nutrition panel concluded that a healthy diet for people aged 2 years and older is higher in vegetables, fruits, legumes, nuts, whole grains, fish, and vegetable oils that are higher in unsaturated fat. It is lower in red and processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fat. It may also include fat-free or low-fat dairy and foods lower in sodium and may include plant-based foods.
The panel, which met for nearly 2 years, was the first to focus on the dietary needs of Americans through what they called a “health equity lens,” said Fatima Cody Stanford, MD, MPH, MPA, an obesity expert at Massachusetts General Hospital who was part of the group. That meant considering factors such as household income, race, ethnicity, and culture when recommending healthy diets. This will help ensure that the guidance “reflects and includes various population groups,” she said in an email.
Ultraprocessed Foods and Alcohol
Ultraprocessed foods include the snacks, sugary cereals, and frozen meals that make up about 60% of the American diet.
The panel considered more than 40 studies, including several that showed links between ultraprocessed foods and becoming overweight or developing obesity. But the nutrition experts had concerns with the quality of the research, leaving them to conclude that the evidence was too limited to make recommendations.
That decision is likely to bump up against the views of Robert F. Kennedy, Jr., the nominee to lead HHS who has questioned potential conflicts of interest among members of the dietary guidelines panel and vowed to crack down on ultraprocessed foods that contribute to chronic disease.
The panel also didn’t revise recommendations that suggest limiting alcohol intake to two drinks or less a day for men and one drink or less a day for women.
In 2020, the last time the guidance was updated, the government rejected the advice of scientific advisers to recommend less alcohol consumption.
Two groups — the National Academies of Science, Engineering, and Medicine and a committee of the government agency that oversees substance abuse — are expected to release reports in the coming months on the effects of moderate alcohol use to inform the guidelines.
Do Americans Follow Guidelines?
The advisory panel acknowledged that the diets of most Americans don’t meet the current guidelines. More than half of all U.S. adults have one or more diet-related chronic health conditions and 18 million U.S. households have insecure sources of food, according to the report.
“Nutrition-related chronic health conditions and their precursors continue to threaten health through the lifespan,” the report concluded. “Which does not bode well for the future of health in the United States.”
What Happens Next?
The scientific report informs the dietary guidelines, which are updated every 5 years. Tuesday’s recommendations now go to HHS and the Agriculture Department, where officials will draft the final guidance set for release next year.
Starting Wednesday, the public will have 60 days to comment on the guidance. HHS and USDA officials will hold a public meeting Jan. 16 to discuss the recommendations.
The new guidance, which will be finalized by the incoming Trump administration, is consistent with decades of federal efforts to reduce diet-related disease in the U.S., said Peter Lurie, MD, president of the advocacy group Center for Science in the Public Interest.
“Broadly, I think these are well-formulated recommendations that the incoming administration would do well to adopt,” Lurie said.

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The office of Senate Majority Leader Chuck Schumer (D-N.Y.) said that this week he will bring the HEARTS Act, the bipartisan legislation to equip schools with automatic external defibrillators and provide CPR training to laypeople, to the Senate floor for a vote on it becoming law.
A novel four-stage myocarditis classification was released in the American College of Cardiology’s new Expert Consensus Decision Pathway for the diagnosis and management of acute myocarditis in adults.
Unlike the steady or slightly downward trends in the prevalence of heart failure in general populations around the world, the burden of heart failure is still increasing in young people ages 10-24 years. (eClinicalMedicine)
In younger generations of Americans in particular, total cholesterol and triglyceride level improvements are decelerating on a population level. Adverse trends in glucose are all the while mediated partially by rising BMIs. (JAMA Network Open)
Positive topline results for the lipid-lowering agent obicetrapib in the phase III BROADWAY trial were announced by NewAmsterdam.
Cohort studies suggest that different sources of sugar have different effects on cardiovascular risk — the occasional sweet treat being associated with better outcomes than no treats at all. (Frontiers in Public Health)
Proinflammatory diets may have varying ties to cardiovascular risk in women, depending on their history of adverse pregnancy outcomes such as preterm birth and gestational diabetes. (Journal of the American Heart Association)
For primary care patients, a person’s estimated “heart age” should not be conflated with a cardiovascular risk score, according to an observational study. (Heart)
Safety fears surrounding paclitaxel-coated peripheral arterial revascularization devices in 2018 were followed by a marked decrease in use of them and an accompanying increase in mortality. (Journal of the American College of Cardiology)
Gene variants associated with increasing transthyretin tetramer destabilization were indeed linked to all-cause and cardiovascular mortality in a Danish cohort study. (JAMA Cardiology)
On the basis of genetic susceptibility, some people may be particularly vulnerable to the air pollution-ventricular arrhythmia relationship. (European Journal of Preventive Cardiology)
A protein panel showed promise for detecting subclinical, anthracycline-associated cardiomyopathy among survivors of childhood cancer. (JACC: CardioOncology)
Biologic treatment of psoriasis was associated with survival and cardiovascular benefits, relative to traditional medications or apremilast (Otezla), in a retrospective study. (eBioMedicine)
Japanese researchers made a case for more adjunctive treatments tackling hemodynamic impairment after stroke thrombectomy, given their case series showing that successful recanalization does not always result in immediate tissue reperfusion. (Stroke)

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

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Researchers identified 13 proteins that predicted how quickly or slowly a person’s brain aged. (Nature Aging)
Midlife anxiety was common decades before people developed dementia, the Norwegian HUNT study showed. (Alzheimer’s & Dementia)
Investigational tavapadon met its primary endpoint in a flexible dosing phase III trial of Parkinson’s disease, showing improvements from baseline in symptoms and quality of life scores at week 26, AbbVie announced.
The p38MAP kinase alpha enzyme inhibitor neflamapimod missed its primary and secondary endpoints in a phase II study of dementia with Lewy bodies, CervoMed said.
Neurodegeneration in the cortical sulcus was a feature of chronic traumatic encephalopathy and was associated with repetitive head impacts, autopsy data showed. (Acta Neuropathologica)
People with amyotrophic lateral sclerosis or cancer were more likely than others to choose assisted dying regardless of where they lived, an analysis found. (JAMA Internal Medicine)
Dementia risk was higher among former soccer players in Scotland despite modifiable dementia risk factors being lower or no different than population controls. (JAMA Network Open)
Diverse cell types in the brain parenchyma contribute to neuroinflammation in Alzheimer’s disease, a review showed. (Nature Reviews Immunology)
The Washington Post highlighted award-winning images documenting a grandmother’s challenges with Alzheimer’s.
CNN looked at Michael J. Fox’s fight against Parkinson’s.

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

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SAN DIEGO — Kids with sickle cell disease who underwent allogeneic stem cell transplantation (allo-SCT) had fewer serious disease complications along with better quality-of-life and cognitive outcomes a decade later, updated findings from a French trial showed.
The prospective study involved 67 children with a history of abnormal cerebral velocities receiving blood transfusions for their disease. At 10 years, patients with a matched sibling donor who underwent allo-SCT had lower mean rates of hospitalization and vaso-occlusive crises (VOCs) compared with kids without a donor receiving standard care (chronic transfusion or hydroxyurea):Hospitalizations: 0.2 vs 6.1, respectively (P

Bitterman is an orthopedic surgeon.

Honesty is the lifeblood of the doctor-patient relationship. Without it, even the most skilled physician is working with one hand tied behind their back. I learned this firsthand with a patient who sought elective surgery for a toe deformity. She withheld two crucial facts: she smoked and had a previous infection after surgery elsewhere. These omissions had serious consequences, complicating her recovery and increasing her risk of further problems.
I wish I could say this case was unique. The truth is, surveys have shown that patients are not fully truthful in nearly half of all cases.
Patients often withhold information, sometimes due to fear or embarrassment, other times due to misunderstanding the relevance of certain details. The repercussions can be severe. In my patient’s case, knowing about her smoking and prior infection would have fundamentally changed my approach. Smoking significantly impairs wound healing and elevates surgical risks. A previous infection raises the possibility of lingering bacteria that could compromise the new surgical site.
Had I been aware of these factors, I could have postponed the surgery, required smoking cessation prior to the procedure, or ordered additional tests to ensure her safety. This lack of information prevented me from making fully informed decisions and providing the best possible care.
Orthopedic surgery, in particular, requires a comprehensive understanding of the patient’s overall health and lifestyle. We consider everything from their mobility and home support system to their detailed medical history, current medications, and lifestyle choices.
Checklists help us identify high-risk conditions like diabetes and smoking, but these tools are only as good as the information provided. Post-operative compliance is another critical area where honesty is paramount. Restrictions on weight-bearing, for example, are essential for proper healing. When patients don’t adhere to these guidelines, it can lead to increased pain, complications, and even worse outcomes. Soiled dressings or casts can sometimes be a telltale sign of non-compliance, prompting further investigation and difficult conversations. Building a relationship where patients feel comfortable admitting these struggles is crucial for their well-being.
Modern medicine relies heavily on data-driven decisions and evidence-based practices. Risk calculators, for example, use factors like smoking, infection history, and other comorbidities to predict potential complications and guide treatment plans. However, these tools are rendered ineffective without accurate and complete patient information. Inaccurate data leads to imprecise calculations, putting patient safety at risk. The effectiveness of these evidence-based tools is entirely dependent on the integrity of the information inputted.
Creating an environment that fosters open communication is essential for encouraging honesty in the doctor-patient relationship. Patients need to feel safe, understood, and free from judgment when sharing sensitive information. This requires active listening on the part of the physician, empathy, and a genuine commitment to a collaborative partnership. Sometimes, involving behavioral health professionals can be beneficial in breaking down communication barriers and addressing underlying anxieties or fears. It’s important to remember that patients may withhold information for a variety of reasons, and addressing those root causes is key.
Ultimately, the best outcomes arise from a strong, honest, and trusting doctor-patient relationship. When patients feel safe, understood, and respected, they are more likely to share crucial details, empowering physicians to provide the most effective and personalized care.
Honesty isn’t just about telling the truth; it’s about building trust, fostering collaboration, and ensuring the best possible health outcomes. It’s about creating a partnership where both the patient and physician work together towards a common goal: optimal health and well-being. Open communication is the foundation upon which successful treatment is built.
Adam Bitterman, DO, is an orthopedic surgeon at Northwell Health, New York’s largest health system.

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